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2020-2021 Clinton-Massie Local Home Ed Notification Form
A parent who elects to provide home education shall supply the following information to the superintendent.
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* Indicates required question
Parent First Name
*
Your answer
Parent Last Name
*
Your answer
Parent Address
*
Your answer
Parent City
*
Your answer
Parent State
*
Your answer
Parent Zip
*
Your answer
Parent Phone #
*
Your answer
Parent Email
*
Your answer
Do you prefer to communicate primarily by email?
*
Yes
No
Full name and birth date of child to be educated at home:
Child 1 First Name
*
Your answer
Child 1 Last Name
*
Your answer
Child 1 Date of Birth
*
MM
/
DD
/
YYYY
Child 1 Grade Level
Choose
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Grade 8
Grade 9
Grade 10
Grade 11
Grade 12
Would you like to add another child?
*
Yes
No
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